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Chest X-radiograph interpretation (Interpretation (Bones Check all ribs…
Chest X-radiograph
interpretation
Definition
Medical imaging of the chest
(heart, lungs, upper abdomen)
using X-rays
Method
View
PA on inspiration
AP in emergencies (magnifies heart, elevates diaphragm, scapula in the way, if supine air/fluid dist will be altered so harder to see e.g. consolidations, effusions)
Physiology
X-rays from beam to detector
Film is white, X-rays darken film
Interpretation
Bones
Check all ribs, clavicles, spine
Easier to look at ribs from the side (90 degrees)
C) Cardiovascular
Heart (position, size, borders, mediastinum)
Costophrenic and cardiophrenic angles
Should be <50% thoracic diameter
A) Airway
Central trachea or deviated
(collapse, pneumothorax)
D) Diaphragm
Raised/flat, gas
Quality
Penetration (spinous processes)
View (all of lung fields)
Rotation (end of clavicles to spinous processes)
Inspiration (5-7 ant ribs)
Everything else
Foreign object (ETT, NG, drains, valves, clips, pacemakers)
Calcification
Admin
Patient name, ID, age
Date the CXR was taken
Direction (AP, PA)
Orientation (L and R)
F) Fields
Lung fields (opacities, nodules, fluid, consolidation)
G) Gas
Gaas under diaphragm
H) Hila
Enlargement, calcification
Lymphadenopathy
Enlarged vasculature
Batwing appearance
Terminology
Abnormalities
Nodules (small dots)/masses (larger)
Consolidation (fluffy, ill definted)
Reticular (crosscross lines)
Kerley B (horizontal lines)
Cavitation (nodule/mass with central air)
Pleural effusion (dense consolidation, concave upward margin)
Pneumothorax (dense black zone, see outer lung edge)
Silhouette sign
Normally structures of same density cannot see border between them
If collapse/consolidation of a lung lobe, will see division between the two lobes
Density
Bone/metal: white, well defined
Soft tissue: white, poorly defined
Fat: grey, darker than soft tissue
Air: black
Mediastinal contours
RA, aortic bump/knuckle, SVC,
aortic arch, LV